Saturday, September 13, 2014

A terrible burden imposed on doctors

Please take a look at this short video from Danielle Ofri, author of What Doctors Feel.

A perceptive quote from her:

"As doctors, if we fail, it’s not something outside of us; it is us. We are the error. The shame is so powerful that most doctors will never come forward about an error. I think the socialization of doctors makes it extremely hard for us to admit a mistake. We tend to pick perfectionists as medical students, knowing that the medical system is not for the faint of heart. Then they’re trained to be perfectionist doctors. There’s no place for a 'good enough" doctor. You’re either excellent or terrible."

This is a awful burden, one reinforced by the medical education process, especially during many residency programs.  I wonder how to get those involved in medical education to understand that this attitude contributes to patient harm.

Thanks to Gene Lindsey for pointing out the article and video.  He also sends us to view some thoughts from Justin Locke, author of Principles of Applied Stupidity:

We all are imperfect of course, but our society is intolerant of such things, and demands that we conceal it. Doctors are under particular cultural pressure to “be perfect.” But when it comes to medical error, shame energy can actually blind the mind to reality. The ongoing pretense that we “don’t make mistakes” is a leading cause of why the mistakes we make don’t get acknowledged, much less fixed.

Our immersion in what I call “smartism” starts early and is taught systematically. We attach enormous shame (i.e., inner-directed personal loathing of self) to failing tests in school, and enormous pressure to get into Harvard. This is a flawed system. There is no big victory for the “A” students; they start to think that their social acceptance is based solely on superstar performance, and they become fractured spirits, becoming human doings instead of human beings. Instead of a sense of social teamwork, shame energy, i.e., our intolerance of the reality of our imperfections, puts us in an unwinnable bitter battle to always be better than someone else. No matter how well you do in such a battle, you lose, for in the end, you do not have community acceptance, the glorious opposite of the dark energy of shame.


Justin Locke said...

Dear Mr. Levy,

This is quite an honor to be mentioned in your blog! I have been a fan of yours for quite a while. Best, Justin Locke

Anonymous said...

Very true, but to take away the internalized shame, you would also have to take away the internalized sense of perfection and complete control which is the primary impetus for entering the profession for most medical students. In other words, the ego trip of being a doctor and one of the most accomplished members of society and the mentality of being captain of the ship in medical situations goes hand in hand with the mentality that it is your fault if things go wrong. Most doctors aren't willing to give up the former, so how do you deal with the latter?

Anonymous said...

I have a bigger problem with docs who have this attitude. Ask any patient that is medically savvy or wants to be involved in their care. I would rather have someone check or ask or something, because there is no way now someone can know everything. I'm fine with that - just the perfectionist attitude.

Justin Locke said...

Dear Anonymous1,

You make a very good point, and ask an excellent question. I hope Mr. Levy won't mind if I weigh in.

The issue of shame based behavior is sometimes a chicken and the egg question. People with issue of trauma-based shame feelings need to compensate, and one goes with the other. Once people "heal" past their personal shame injuries, the symptoms-- e.g., of compensating by always being "perfect," -- tend to go away by themselves. (Easier said than done of course.)

But I wanted to say something else, which is, we often take industrial approaches to systemic problems, i.e., "find the broken part and fix or replace it." In this case, we are all over the doctors here and their issues and behaviors. But the problem is not just in them. For example, when Johnny fails geometry class, does Johnny need to be fixed, or does the entire school system need to be re-examined? We often place blame on the student, or the parents, or the teachers, but the problem is not in any one group, it is whole and systemic. Big point: the problem always lies within the structure of the system, not in any one person or grouping of individuals. Individuals, even CEOs, usually do not have enough power to alter the system energy. The medical industrial complex has many players besides doctors. There's Medicare, the ACA, the insurance companies, the drug companies, injury law, the medical schools . . . and the doctors are caught in the middle having to take all the heat.

Shame energy maintains itself in systems by distracting us from the big picture, making us look for a quick and easy scapegoat instead of taking collective blame, and thus maintains the status quo. It is a fascinating aspect of organization behavior, one that is seldom discussed and often seen as taboo, but in my view is the crux of the issue in moving ahead as a society.

Paul Levy said...

Exactly so!